Editing Segmental ureterectomy (section)

== Ileal ureter replacement ==
* When a long segment of ureter is diseased, a segment of ileum can be used to reconstruct the urinary system. The appendix has also been used for segmental ureteral substitution
* Through a midline intraperitoneal incision, 20 to 25 cm of ileum is harvested at least 15 cm away from the ileocecal valve. Bowel continuity is re-established using a stapled anastomosis. With a running absorbable suture, the ileal segment is anastomosed to the renal pelvis proximally in an end-to-end fashion and an isoperistaltic direction. If the proximal portion of the ureter is healthy, the ileal segment can be anastomosed to it in an end-to-side fashion. A ureteral catheter is placed before completion of the anastomosis. Distally, the segment is anastomosed to the posterior wall of the bladder in an end-to-side manner through an intravesical approach. This anastomosis is done in two layers. A suction drain is positioned in retroperitoneum close to anastomotic sites. Optimal drainage is important for proper healing, so a large Foley catheter is inserted in the bladder and left for at least 1 week postoperatively. It may need to be irrigated frequently. A nephrostomy tube may be used to drain the kidney. Before removal of the tubes, a cystogram and nephrostogram are obtained.